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On the Cover

Formal training for nurses in the United States began in 1873, and this was mostly "on the job" training. Nursing school students were a source of cheap labor at the time—they provided patient care in hospitals in return for classes. When they graduated, only a few hospital positions were available, and nurse graduates relied on securing positions as private nurses, mostly for wealthy families. They were hired based on recommendations from family physicians or joined hospital "registries" where they were referred to patients needing home care. These nurses, however, struggled financially, especially in times of recession, when their patients' incomes dwindled.

Currently, the weak U.S. economy has depleted the number of available hospital jobs, and, like their earlier counterparts, today's graduates are facing a tough job market. Nursing students worry how long this dry spell will last.

The image on our cover shows two generations of nursing school graduates. On the left, and also on this page, are nurses from Harper Hospital in Detroit's nurse training school in 1898. In the center, facing the camera, is Sarah E. Sly, who would become president of the American Nurses Association in 1911 and a member of AJN's board of directors in 1910. On the right of the cover image are students from the class of 2011 of Ramapo College School of Nursing's Englewood Campus in Englewood, New Jersey. The photograph was taken in September 2009 by Mary Lloyd, MSN, RN, CNE, at Englewood Hospital and Medical Center.

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